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Qi K, Liu Y, Wang Z, Xiong X, Cai K, Xu Y, Shi Y, Sun Z, Dong X, Chen A. Recreational ball games are effective in improving social communication impairments among preschoolers diagnosed with autism spectrum disorder: a multi-arm controlled study. BMC Sports Sci Med Rehabil 2024; 16:176. [PMID: 39175073 PMCID: PMC11342502 DOI: 10.1186/s13102-024-00957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 08/01/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND This study aimed to compare the effects of two 12-week training intervention experimental ball games combined with standard behavioral rehabilitation against a control group solely utilizing standard behavioral rehabilitation on social communication impairments (SCI) in preschool children with Autism Spectrum Disorder (ASD). METHODS A multi-arm controlled study design was implemented, involving 41 children diagnosed with ASD (mean age: 4.99 ± 0.76 years). 41 participants were randomized assigned to two experimental groups and a control group, The experimental group carried out ball combination training program group (BCTP) and mini-basketball training program group (MBTP) on the basis of routine behavioral rehabilitation, which underwent 12-week training interventions 5 times a week. The control group (n = 14) received only standard behavioral rehabilitation. Evaluations were conducted before and after interventions using the Social Responsiveness Scale, Second Edition (SRS-2). RESULTS The results suggest that both 12-week interventions, BCTP, and MBTP, led to significant improvements in social communication impairment among children with ASD (p < 0.05). Despite enhancing the overall scores on the SRS-2, these interventions displayed varying impacts across different sub-dimensions. BCTP primarily exhibited significant enhancements in social awareness and behavior pattern (p < 0.05), whereas MBTP significantly improved social cognition and social communication (p < 0.05). Both interventions showed slight improvements in social motivation. CONCLUSIONS The utilization of recreational ball games has showed to be effective in decreasing the impairment levels of children with ASD, while the control group experienced a worsening of outcomes. This suggests that irrespective of the specific ball game strategy employed, both can be employed on a weekly basis to complement standard behavioral rehabilitation and enhance the ability to improve the quality of life for children diagnosed with ASD. TRIAL REGISTRATION The trial is retrospectively registered on the Chinese Clinical Trial Registry (ChiCTR1900024973;August 5, 2019).
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Affiliation(s)
- Kai Qi
- Gdansk University of Physical Education and Sport, Gdansk, 80-336, Poland
| | - Yufei Liu
- Gdansk University of Physical Education and Sport, Gdansk, 80-336, Poland
| | - Zuopeng Wang
- Jiamusi University, Jiamusi, Heilongjiang, 154007, China
| | - Xuan Xiong
- Nanjing University, Nanjing, Jiangsu, 210008, China
| | - Kelong Cai
- Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - Yifan Xu
- Gdansk University of Physical Education and Sport, Gdansk, 80-336, Poland
| | - Yifan Shi
- Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - Zhiyuan Sun
- Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - Xiaoxiao Dong
- Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - Aiguo Chen
- Nanjing Sport Institute, Nanjing, Jiangsu, 210014, China.
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Aishworiya R, Saw YE, Chan YH, Chong SC, Kiing JSH, Tan MY, Lim TSH, Mulay KV, Kang YQ. Quality of Life and Its Associated Correlates of Parents of Children on the Autism Spectrum in Singapore. J Autism Dev Disord 2024:10.1007/s10803-024-06391-6. [PMID: 38773032 DOI: 10.1007/s10803-024-06391-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 05/23/2024]
Abstract
This cross-sectional study aimed to assess Quality of life (QoL) of parents of children on the autism spectrum in Singapore and identify its associated factors. Parents of children (age ≥ 5 years) completed the Quality of Life in Autism scale which measures parental self-rated QoL (higher scores denote greater QoL), and the perceived impact of the child's autism-related behaviors on parents (higher scores denote lesser impact). Information on the child's degree of autism (measured by the Social Responsiveness Scale, second edition [SRS-2]), community and social participation and cognitive and adaptive functioning were also obtained. Participants were 86 parents with mean child age 6.3 years (SD 1.0). Univariate analysis results revealed greater participation in community and social events to be two modifiable factors associated with higher parental QoL. However, these factors were not found to be significant in the multivariate model. Higher autism features (represented by higher parent-rated SRS scores) was associated with a greater perceived impact of the child's behaviors by parents in both univariate and multivariate analyses. Of note, child's cognitive or adaptive skills were not significantly associated with either QoL measure. Equipping parents to handle autism-related behaviors can be useful to reduce their impact on parental QoL. Facilitating community participation for these children may positively influence caregiver QoL as well.
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Affiliation(s)
- Ramkumar Aishworiya
- Child Development Unit, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Young Ern Saw
- Child Development Unit, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shang Chee Chong
- Child Development Unit, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jennifer S H Kiing
- Child Development Unit, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mae Yue Tan
- Child Development Unit, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tammy Su Hui Lim
- Child Development Unit, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kalyani Vijaykumar Mulay
- Child Development Unit, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Qi Kang
- Child Development Unit, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Kara K, Kara OK, Sutcu G, Tonak HA. The Relationship Between Fatigue and Quality of Life in the Turkish Mothers of Children with Autism Spectrum Disorder. J Autism Dev Disord 2024:10.1007/s10803-024-06398-z. [PMID: 38764072 DOI: 10.1007/s10803-024-06398-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
This study aimed to investigate the different effects of fatigue and health-related quality of life in the Turkish mothers of children with autism spectrum disorder (ASD) through comparisons with mothers of typically developing children, and to evaluate the relationship between different aspects of maternal fatigue, depression, and maternal health-related quality of life. The study included a total of 103 mothers, comprising 60 mothers of children with ASD and 43 mothers of typically developing children. The Nottingham Health Profile and Quality of Life in Autism Questionnaire-Parent Version were used to assess the health-related quality of life. Fatigue was assessed comprehensively with the Fatigue Impact Scale and the Fatigue Severity Scale. The Nottingham Health Profile total and physical mobility domain and the quality of life were the strongest factors, explaining with a variance of 66.7% the fatigue impact on cognitive function. The mothers' quality of life accounted for 64.8% of the variance in factors that explained fatigue. Physical mobility, social isolation and quality of life were associated with the physical impact of fatigue and were explained with a variance of 52.4%. Emotional reactions and quality of life were explained with a variance of 52.7% in the fatigue of psychosocial function. The current study has highlighted that the fatigue of Turkish mothers of children with ASD has a greater impact on cognitive, physical and psychosocial functions. Furthermore, the quality of life, physical mobility, social isolation, and emotional reactions of mothers have a significant impact on maternal fatigue.
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Affiliation(s)
- Koray Kara
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Ozgun Kaya Kara
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Akdeniz University, Antalya, Turkey
| | - Gulsah Sutcu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Akdeniz University, Antalya, Turkey
| | - Hasan Atacan Tonak
- Hamidiye Faculty of Health Sciences, Department of Occupational Therapy, University of Health Sciences, Istanbul, Turkey
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Backman E, Åsberg Johnels J, Thunberg G. Parental perceptions of social life before and after attending a parent training program for children with complex communication needs: the ComAlong example. Augment Altern Commun 2024; 40:46-56. [PMID: 37768212 DOI: 10.1080/07434618.2023.2262036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Parent training programs aimed at improving language outcomes for children with complex communication needs have predominantly been evaluated on child-centered outcomes and less often on the impact on social life or parental well-being. This study examined parent perceptions of social life before and after ComAlong, a group intervention providing parents with knowledge and training in responsive communication, environmental-milieu teaching strategies and augmentative and alternative communication (AAC). Parents (N = 467) completed questionnaires during the first and last sessions of ComAlong groups held in Sweden 2012 to 2018. Main outcome measure was change in the Social Life Scale from the Family Impact Questionnaire. Associations between this measure and demographic factors of parents and children were analyzed, along with reported change in parents' use of AAC. Pre-post comparisons revealed small significant positive changes in perceived impact of social life following intervention. The magnitude of the positive change was larger among parents of children with non-syndromic diagnoses and parents of children with autism spectrum disorder or attention deficit hyper activity disorder (ADHD). Differences in social life impact was not associated with parents' gender, language proficiency, age, or educational background. In conclusion, communication-focused parent training programs can have a positive impact on social family life and may thereby influence children's participation.
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Affiliation(s)
- Ellen Backman
- Regional habilitation center, Region Halland, Sweden
- Department of Social Sciences, Marie Cederschiöld University College, Sweden
| | - Jakob Åsberg Johnels
- Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Gunilla Thunberg
- DART centre for AAC and AT, Sahlgrenska University Hospital, Gothenburg, Sweden
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Palmer JK, van der Pols JC, Sullivan KA, Staudacher HM, Byrne R. A Double-Blind Randomised Controlled Trial of Prebiotic Supplementation in Children with Autism: Effects on Parental Quality of Life, Child Behaviour, Gastrointestinal Symptoms, and the Microbiome. J Autism Dev Disord 2024:10.1007/s10803-024-06239-z. [PMID: 38291245 DOI: 10.1007/s10803-024-06239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE Modifying gut bacteria in children with autism may influence behaviour, with potential to improve family functioning. We conducted a randomised controlled trial to assess the effect of prebiotics on behaviour, gastrointestinal symptoms and downstream effects on parental quality of life. METHOD Children with autism (4-10yrs) were randomised to 2.4 g/d of prebiotic (GOS) or placebo for six weeks. Pre and post stools samples were collected, and validated questionnaires used to measure change in social and mealtime behaviours, GI symptoms and pQOL. Linear mixed models evaluated group differences for behavioural variables, and Mann Whitney U tests were used to compare change between-groups for GI symptoms, differential abundance of genera and alpha diversity of the microbiome. RESULTS Thirty-three parent-child dyads completed the trial. No group difference was seen for behavioural variables but both groups improved significantly from baseline. There was a medium effect size between groups for GI symptoms (d = 0.47) and pQOL (d = 0.44) driven by greater improvements in the prebiotic group. Bifidobacterium increased threefold following prebiotics (1.4-5.9%, p < 0.001) with no change in controls. Supplements were well tolerated, compliance with dose 94%. CONCLUSION Prebiotics modify levels of Bifidobacterium and prove well tolerated but in this instance, resulted in only marginal effects on GI symptoms and pQOL. A larger sample of children with more severe symptoms could help to determine the potential of prebiotics in autism. TRIAL REGISTRATION https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619000615189 .
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Affiliation(s)
- Jacqueline K Palmer
- School of Exercise and Nutrition Science, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Jolieke C van der Pols
- School of Exercise and Nutrition Science, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Karen A Sullivan
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Heidi M Staudacher
- Food & Mood Centre, School of Medicine, Barwon Health, IMPACT Institute, Deakin University, Geelong, VIC, Australia
| | - Rebecca Byrne
- School of Exercise and Nutrition Science, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Volgyesi-Molnar M, Gyori M, Eapen V, Borsos Z, Havasi A, Jakab Z, Janoch L, Nemeth V, Oszi T, Szekeres A, Stefanik K. Quality of Life in Hungarian Parents of Autistic Individuals. J Autism Dev Disord 2024:10.1007/s10803-024-06243-3. [PMID: 38280137 DOI: 10.1007/s10803-024-06243-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/29/2024]
Abstract
PURPOSE Parents of autistic individuals have been known to have a lower overall quality of life (QQL) than those of typically developing children. We present the first Hungarian large-sample study whose objective was to explore the differences in QOL between parents of autistic individuals (AS) and those of neurotypical (NT) persons. METHODS Based on the ABCX model we developed a questionnaire comprising standardized scales to characterize the life of parents involved. Our data came from parents of 842 individuals (ASD = 521, NT = 321) between 0 and 49 years. Battery deployed standardized instruments to examine quality of life (WHO-QQL BREF and Quality of Life in Autism questionnaire, QOLA). We assessed the families' socio-economic/demographic characteristics, parents' psychological well-being, the autistic/neurotypical individuals' characteristics, and the interventions. RESULTS Our data showed significantly lower QOL in parents of autistic individuals in all domains of questionnaires. We analyzed 20 relevant factors to uncover the predictors of parental QOL. We confirmed the existence of most but not all predictors present in earlier literature and identified intervention-related predictors. CONCLUSION Our study confirms the importance of supporting parents in their role, and of providing health and social supports that focus on quality of life, in addition to child care.
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Affiliation(s)
- Marta Volgyesi-Molnar
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary.
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary.
| | - Miklos Gyori
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District & Ingham Institute, Liverpool, Australia
| | - Zsofia Borsos
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute for the Psychology of Special Needs, ELTE University, Budapest, Hungary
| | - Agnes Havasi
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
| | - Zoltan Jakab
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute for the Psychology of Special Needs, ELTE University, Budapest, Hungary
| | - Laszlone Janoch
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
| | - Vivien Nemeth
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
- Faculty of Education and Psychology, Doctoral School of Education, ELTE University, Budapest, Hungary
| | - Tamasne Oszi
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
| | - Agota Szekeres
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
- Hungarian University of Agriculture and Life Sciences, Institute of Education, Kaposvar, Hungary
| | - Krisztina Stefanik
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
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Lagod PP, Naser SA. The Role of Short-Chain Fatty Acids and Altered Microbiota Composition in Autism Spectrum Disorder: A Comprehensive Literature Review. Int J Mol Sci 2023; 24:17432. [PMID: 38139261 PMCID: PMC10743890 DOI: 10.3390/ijms242417432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by deficits in communication and social interactions, restrictive and repetitive behavior, and a wide range of cognitive impediments. The prevalence of ASD tripled in the last 20 years and now affects 1 in 44 children. Although ASD's etiology is not yet elucidated, a growing body of evidence shows that it stems from a complex interplay of genetic and environmental factors. In recent years, there has been increased focus on the role of gut microbiota and their metabolites, as studies show that ASD patients show a significant shift in their gut composition, characterized by an increase in specific bacteria and elevated levels of short-chain fatty acids (SCFAs), especially propionic acid (PPA). This review aims to provide an overview of the role of microbiota and SCFAs in the human body, as well as possible implications of microbiota shift. Also, it highlights current studies aiming to compare the composition of the gut microbiome of ASD-afflicted patients with neurotypical control. Finally, it highlights studies with rodents where ASD-like symptoms or molecular hallmarks of ASD are evoked, via the grafting of microbes obtained from ASD subjects or direct exposure to PPA.
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Affiliation(s)
| | - Saleh A. Naser
- Division of Molecular Microbiology, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 4110 Libra Drive, Orlando, FL 32816, USA;
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Ran Q, Tu L, Wu Y, Zhang S, Zhang E, Li H, Su Y, Xiang M. Formal social support and quality of life of caregivers with autistic children: a large-scale nationwide survey in China. Front Public Health 2023; 11:1282778. [PMID: 38179564 PMCID: PMC10766108 DOI: 10.3389/fpubh.2023.1282778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Caregivers of children with autism spectrum disorder (ASD) were reported poor quality of life (QOL). Formal social support might improve the QOL of caregivers, however, limited research to date has focused on this association in China and formal social support for this group is conspicuously lacking. The study was aim to understand the QOL in male and female caregivers with ASD children in China and to explore the relationship between QOL and formal social support for caregivers with children with ASD through a large-scale nationwide survey. Methods An online questionnaire was used to conduct a cross-sectional study with a sample of 6,120 caregivers of children with ASD. Relationship between Quality of Life and several potential predictors is measured and analyzed. Quality of life were measured by Medical Study Short-Form Health Survey version 2 (Chinese version). Multivariate logistic regression analysis was used to analyze the factors affecting caregivers' QOL. Results The results revealed that the QOL of caregivers of autistic children in China was poor especially male caregivers. Social support was a positive predictor. More importantly, formal social support from rehabilitation institutions can improve caregivers' physical QOL. Caregivers' satisfaction with the rehabilitation institutions affecting their physical and mental QOL. Conclusion The formal social support provided by rehabilitation institutions plays a positive role in improving the quality of life of caregivers.
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Affiliation(s)
- Qingqing Ran
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Liangzhi Tu
- College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinghui Wu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | | | - Erliang Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Huilun Li
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Ya Su
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Mi Xiang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
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Rivard M, Morin D, Coulombe P, Morin M, Mello C. The Diagnostic Period for Autism: Risk and Protective Factors for Family Quality of Life in Early Childhood. J Autism Dev Disord 2023; 53:3755-3769. [PMID: 35917021 DOI: 10.1007/s10803-022-05686-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
During the diagnostic evaluation period for autism or intellectual disability (ID), families of young children are at risk for poor adjustment. The present study aimed to document family quality of life (FQOL), along with associated risk and protective factors, during this critical step of families' services trajectory. FQOL was measured in a large sample of families of children recently diagnosed with a neurodevelopmental disorder and examined in relation to the type of services received, children's clinical profile, and family variables. FQOL was related to types of services, children's challenging behavior, parenting stress, and several aspects of family composition and status. These findings highlight a need for mental health support for parents, coaching interventions for challenging behaviors, and family-centered supports.
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Affiliation(s)
- Mélina Rivard
- Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, H3C 3P8, Montréal, Québec, Canada.
| | - Diane Morin
- Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, H3C 3P8, Montréal, Québec, Canada
| | | | - Marjorie Morin
- Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, H3C 3P8, Montréal, Québec, Canada
| | - Catherine Mello
- The Pennsylvania State University - Berks, 19610, Reading, PA, USA
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Chu L, Shen L, Ma C, Chen J, Tian Y, Zhang C, Gong Z, Li M, Wang C, Pan L, Zhu P, Wu D, Wang Y, Yu G. Effects of a Nonwearable Digital Therapeutic Intervention on Preschoolers With Autism Spectrum Disorder in China: Open-Label Randomized Controlled Trial. J Med Internet Res 2023; 25:e45836. [PMID: 37616029 PMCID: PMC10485722 DOI: 10.2196/45836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disorder that can cause difficulty with communication and social interactions as well as complicated family dynamics. Digital health interventions can reduce treatment costs and promote healthy lifestyle changes. These therapies can be adjunctive or replace traditional treatments. However, issues with cooperation and compliance prevent preschool patients with ASD from applying these tools. In this open-label, randomized controlled trial, we developed a nonwearable digital therapy called virtual reality-incorporated cognitive behavioral therapy (VR-CBT). OBJECTIVE The aim of this study was to assess the adjunctive function of VR-CBT by comparing the effects of VR-CBT plus learning style profile (LSP) intervention with those of LSP-only intervention in preschool children with ASD. METHODS This trial was performed in China on 78 preschool children (age 3-6 years, IQ>70) diagnosed with ASD who were randomized to receive a 20-week VR-CBT plus LSP intervention (intervention group, 39/78, 50%) or LSP intervention only (control group, 39/78, 50%). The primary outcome was the change of scores from baseline to week 20, assessed by using the parent-rated Autism Behavior Checklist (ABC). Secondary outcomes included the Childhood Autism Rating Scale (CARS), Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV), and behavioral performance data (accuracy and reaction time) in go/no-go tasks. All primary and secondary outcomes were analyzed in the intention-to-treat population. RESULTS After the intervention, there was an intervention effect on total ABC (β=-5.528; P<.001) and CARS scores (β=-1.365; P=.02). A similar trend was observed in the ABC subscales: sensory (β=-1.133; P=.047), relating (β=-1.512; P=.03), body and object use (β=-1.211; P=.03), and social and self-help (β=-1.593; P=.03). The intervention also showed statistically significant effects in improving behavioral performance (go/no-go task, accuracy, β=2.923; P=.04). Moreover, a significant improvement of ADHD hyperactivity-impulsivity symptoms was observed in 53 children with comorbid ADHD based on ADHD-RS-IV (β=-1.269; P=.02). No statistically significant intervention effect was detected in the language subscale of ABC (β=-.080; P=.83). Intervention group girls had larger improvements in ABC subscales, that is, sensory and body and object use and in the CARS score and accuracy of go/no-go task (all P<.05) than the control group girls. Statistically significant intervention effects could be observed in hyperactivity-impulsivity symptoms in the intervention group boys with comorbid ADHD compared with those in the control group boys (β=-1.333; P=.03). CONCLUSIONS We found potentially positive effects of nonwearable digital therapy plus LSP on core symptoms associated with ASD, leading to a modest improvement in the function of sensory, motor, and response inhibition, while reducing impulsivity and hyperactivity in preschoolers with both ASD and ADHD. VR-CBT was found to be an effective and feasible adjunctive digital tool. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100053165; http://www.chictr.org.cn/showproj.aspx?proj=137016.
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Affiliation(s)
- Liting Chu
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Division of Child and Adolescent Health, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Li Shen
- Clinical Research Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chenhuan Ma
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinjin Chen
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Tian
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chuncao Zhang
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zilan Gong
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mengfan Li
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chengjie Wang
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lizhu Pan
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peiying Zhu
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Danmai Wu
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Wang
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guangjun Yu
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
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Morris P, Hope E, Foulsham T, Mills JP. Dancing out for a voice; a narrative review of the literature exploring autism, physical activity, and dance. J Bodyw Mov Ther 2023; 33:202-215. [PMID: 36775520 DOI: 10.1016/j.jbmt.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/27/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
Autism Spectrum Disorder is characterised by profound challenges with social communication and social interaction. Currently, there are few therapeutic interventions that successfully target some of the functionally impairing traits associated with autism. Furthermore, many of these interventions comprise a variety of limitations; including, limited accessibility, extensive durations, or the requirement of a trained professional to deliver the intervention. New research suggests that instead of targeting all traits associated with Autism Spectrum Disorder with a single solution, scientific research should focus on providing therapeutic tools that alleviate functionally impairing facets specific to the individual. Owing to the nature of physical activity, sports, and dance (coordinated movement) these activities could provide opportunities to enhance communication skills and social development in autistic children. Therefore, this paper gives a narrative overview of the literature surrounding communication and coordinated movement; outlining what is meant by communication challenges, exploring the benefits of coordinated movement for traits associated with Autism Spectrum Disorder, and delineating how coordinated movement elicits positive outcomes for autistic children.
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Affiliation(s)
- Phoebe Morris
- School of Sport, Exercise Science and Rehabilitation, University of Essex, UK.
| | - Edward Hope
- School of Sport, Exercise Science and Rehabilitation, University of Essex, UK
| | - Tom Foulsham
- Department of Psychology, University of Essex, UK
| | - John P Mills
- School of Sport, Exercise Science and Rehabilitation, University of Essex, UK
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12
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Lu C, Rong J, Fu C, Wang W, Xu J, Ju XD. Overall Rebalancing of Gut Microbiota Is Key to Autism Intervention. Front Psychol 2022; 13:862719. [PMID: 35712154 PMCID: PMC9196865 DOI: 10.3389/fpsyg.2022.862719] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/02/2022] [Indexed: 12/25/2022] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with unclear etiology, and due to the lack of effective treatment, ASD patients bring enormous economic and psychological burden to families and society. In recent years, many studies have found that children with ASD are associated with gastrointestinal diseases, and the composition of intestinal microbiota (GM) is different from that of typical developing children. Thus, many researchers believe that the gut-brain axis may play an important role in the occurrence and development of ASD. Indeed, some clinical trials and animal studies have reported changes in neurological function, behavior, and comorbid symptoms of autistic children after rebalancing the composition of the GM through the use of antibiotics, prebiotics, and probiotics or microbiota transfer therapy (MMT). In view of the emergence of new therapies based on the modulation of GM, characterizing the individual gut bacterial profile evaluating the effectiveness of intervention therapies could help provide a better quality of life for subjects with ASD. This article reviews current studies on interventions to rebalance the GM in children with ASD. The results showed that Lactobacillus plantarum may be an effective strain for the probiotic treatment of ASD. However, the greater effectiveness of MMT treatment suggests that it may be more important to pay attention to the overall balance of the patient's GM. Based on these findings, a more thorough assessment of the GM is expected to contribute to personalized microbial intervention, which can be used as a supplementary treatment for ASD.
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Affiliation(s)
- Chang Lu
- School of Psychology, Northeast Normal University, Changchun, China
| | - Jiaqi Rong
- School of Psychology, Northeast Normal University, Changchun, China
| | - Changxing Fu
- School of Psychology, Northeast Normal University, Changchun, China
| | - Wenshi Wang
- School of Psychology, Northeast Normal University, Changchun, China
| | - Jing Xu
- School of Life Sciences, Northeast Normal University, Changchun, China
| | - Xing-Da Ju
- School of Psychology, Northeast Normal University, Changchun, China
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13
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Vilanova JRS, Carneiro CT, Rocha KNDS, Brito MDA, Rocha RC, Costa ADC, Bezerra MAR. Burden of mothers of children diagnosed with autism spectrum disorder: mixed method study. Rev Gaucha Enferm 2022; 43:e20210077. [PMID: 35613240 DOI: 10.1590/1983-1447.2022.20210077.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the maternal burden related to the care of children diagnosed with autism spectrum disorder. METHOD Study with a mixed-method sequential explanatory design held at the Association of Friends and Families of Special Children and in a WhatsApp® Messenger group, with 51 (quantitative phase) and six (qualitative phase) mothers, between January and October 2019. For data collection, in the quantitative phase, a sociodemographic, economic and child care characterization form and a Zarit Burden Interview instrument were used. Semi-structured interview was used in the qualitative phase. Descriptive bivariate and multivariate analysis (quantitative) and Bardin analysis (qualitative) were performed. RESULTS A total of 64.7% mothers felt burdened, with mild to moderate burden (52.9%). Four analytical categories on elements that trigger maternal burden emerged. CONCLUSIONS There is an urgent need to identify maternal burden related to the care of children with autism spectrum disorder, during assistance in Primary Health Care.
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Affiliation(s)
- Jakelinne Reis Sousa Vilanova
- Universidade Federal do Piauí (UFPI), Campus Amílcar Ferreira Sobral, Departamento de Enfermagem. Floriano, Piauí, Brasil
| | - Cristianne Teixeira Carneiro
- Universidade Federal do Piauí (UFPI), Campus Amílcar Ferreira Sobral, Departamento de Enfermagem. Floriano, Piauí, Brasil
| | | | - Mychelangela de Assis Brito
- Universidade Federal do Piauí (UFPI), Campus Amílcar Ferreira Sobral, Departamento de Enfermagem. Floriano, Piauí, Brasil
| | - Ruth Cardoso Rocha
- Universidade Federal do Piauí (UFPI), Campus Amílcar Ferreira Sobral, Departamento de Enfermagem. Floriano, Piauí, Brasil
| | - Adelianna de Castro Costa
- Universidade Federal do Piauí (UFPI), Campus Amílcar Ferreira Sobral, Departamento de Enfermagem. Floriano, Piauí, Brasil
| | - Maria Augusta Rocha Bezerra
- Universidade Federal do Piauí (UFPI), Campus Amílcar Ferreira Sobral, Departamento de Enfermagem. Floriano, Piauí, Brasil
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14
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Song W, Zhang M, Teng L, Wang Y, Zhu L. Prebiotics and probiotics for autism spectrum disorder: a systematic review and meta-analysis of controlled clinical trials. J Med Microbiol 2022; 71. [PMID: 35438624 DOI: 10.1099/jmm.0.001510] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction. Autism spectrum disorder (ASD) is a neurodevelopmental disorder. The discovery of the influence of gut microbiota on mental illness opens up new research avenues for the role of gut microbiota modifiers, such as probiotics or prebiotics, as a potential course of treatment. Potential treatments have received considerable attention in recent years.Aim. The meta-analysis only included clinical controlled trials to explore whether probiotics and prebiotics can improve the overall severity of ASD symptoms in children, the severity of gastrointestinal (GI) problems and the comorbid psychopathlology in ASD.Gap statement. Although systematic reviews have been conducted in this area in the past, most of them are mixed experimental designs, and the reliability of the conclusions remains to be determined. To the best of our knowledge, no systematic review of randomized controlled trials (RCTs) has been conducted.Methodology. A meta analysis used a combination of subject terms and free words, or used keywords, titles, and abstracts to conduct in PubMed, Web of Science, Embase, and Cochrane Library to identify studies relevant to the current review.Result. The results of the meta-analysis showed that probiotics and prebiotics did not significantly improve the severity of ASD patients, GI problems and comorbid psychopathlology in ASD, and the result is contradictory to the previous literatures.Conclusion. Since there are relatively few clinical controlled trials that can be included, the results of this study still need to be further verified in the clinic. In the future, more randomized controlled studies, more research populations, and the use of more professional clinicians may provide more robust research results.
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Affiliation(s)
- Wenjing Song
- Heilongjiang University of Chinese Medicine, Harbin, PR China
| | - Mei Zhang
- Heilongjiang University of Chinese Medicine, Harbin, PR China
| | - Lili Teng
- Heilongjiang University of Chinese Medicine, Harbin, PR China
| | - Yu Wang
- Heilongjiang University of Chinese Medicine, Harbin, PR China
| | - Luwen Zhu
- Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, PR China
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15
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Coping, social support, and family quality of life for caregivers of individuals with autism: Meta-analytic structural equation modeling. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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ALBusaidi AMS, ALMasroori SAS, Awladthani BMS, ALKhaldi SA, Al Alawi N, Al Salmani AA. Quality of life and coping strategies used by parents of children with autism spectrum disorder in Oman. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415221142262. [PMID: 36466041 PMCID: PMC9716633 DOI: 10.1177/23969415221142262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Raising a child with autism spectrum disorder (ASD) can have a significant impact on quality of life (QOL). This study was conducted to assess the QOL and coping strategies of parents of children with ASD in Oman. METHOD This descriptive cross-sectional study was conducted at Al-Masarra psychiatric hospital. Telephone interviews were conducted with the parents of all children diagnosed with ASD and attending Al-Masarra Hospital between January 2018 and October 2021. Data were collected using the Ways of Coping Checklist-Revised and World Health Organization Quality of Life Assessment-Brief. RESULTS A total of 304 parents participated in the study (response rate: 100%), of which 59.5% were female. The mean age of the parents and children with ASD was 40.4 ± 6.9 and 8.4 ± 2.3 years, respectively. Most children with ASD were male (78.3%) and entirely dependent upon their parents (18.1%). Seeking social support was the most common coping strategy (75.53 ± 13.99), while escape avoidance was the least common (51.78 ± 8.04). Most parents (48.7%) rated their QOL as good to very good, with acceptable scores in the psychological (70.92 ± 11.22) and social (73.27 ± 11.46) domains, borderline in the physical health domain (63.51 ± 7.77), and poor in the environmental domain (58.31 ± 11.00). CONCLUSIONS Omani parents of children with ASD utilize various coping strategies, with coping skills considered a positive index for mental health in general. No significant differences were observed between Omani fathers and mothers in terms of QOL or coping strategies.
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Li F, Xu M, Wu D, Tang Y, Zhang L, Liu X, Zhou L, Li F, Jiang L. From child social impairment to parenting stress in mothers of children with ASD: The role of parental self-efficacy and social support. Front Psychiatry 2022; 13:1005748. [PMID: 36147986 PMCID: PMC9485583 DOI: 10.3389/fpsyt.2022.1005748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Children with autism spectrum disorder (ASD) can exhibit persistent deficits in social communication, causing their mothers to experience elevated parenting stress during the childrearing process. Some internal and external psychosocial resources may mediate or moderate the mother-child relationship, though the underlying mechanisms remain unclear. This study aimed to explore the predictors of parenting stress in mothers of children with ASD and elucidate the mechanisms underlying the relationship between child social impairment and parenting stress. METHODS A cross-sectional study was conducted between October 2020 and March 2022 in Shanghai, China. Mothers of children with ASD completed a survey investigating child social impairment, parenting stress, parental self-efficacy, and social support. RESULTS A total of 185 mothers of children with ASD were included in the final analysis. 70.27 percent of mothers experienced a clinically significant level of parenting stress. Child social impairment (r = 0.46, P < 0.001), parental self-efficacy (r = -0.58, P < 0.001), and social support (r = -0.35, P < 0.001) were significantly correlated with parenting stress. Parental self-efficacy completely mediated the relationship between child social impairment and parenting stress (B = 0.51, P < 0.001), after controlling for socioeconomic status (SES) correlated with parenting stress. There was no significant moderating effect of social support between child social impairment and parenting stress (B = 0.01, P = 0.09). CONCLUSION Future early intervention programs that focused on child's social communication skills and empowered mothers with related strategies through group-based parent training programs may help reduce parenting stress.
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Affiliation(s)
- Fēi Li
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyu Xu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danping Wu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Tang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Faculty of Education, Yunnan Normal University, Kunming, China
| | - Lingli Zhang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Liu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhou
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Psychology and Neuroscience of Cognition Research Unit, University of Liege, Liège, Belgium
| | - Fei Li
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Vilanova JRS, Carneiro CT, Rocha KNDS, Brito MDA, Rocha RC, Costa ADC, Bezerra MAR. Sobrecarga de mães com filhos diagnosticados com transtorno do espectro autista: estudo de método misto. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210077.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: Analisar a sobrecarga materna relacionada aos cuidados com filhos diagnosticados com transtorno do espectro autista. Método: Estudo de método misto, sequencial explanatório, realizado na Associação de Pais e Amigos dos Excepcionais e em grupo de WhatsApp® Messenger, com 51 mães (fase quantitativa) e seis (fase qualitativa), entre janeiro e outubro de 2019. Para coleta de dados, utilizaram-se, na fase quantitativa, de formulário de caracterização sociodemográfica, econômica e do cuidado realizado com o filho; e do instrumento Zarit Burden Interview. Na fase qualitativa, empregou-se uma entrevista semiestruturada. Realizaram-se análise descritiva, bivariada e multivariada (dados quantitativos) e análise de conteúdo de Bardin (dados qualitativos). Resultados: 64,7% das mães se sentiam sobrecarregadas, com sobrecarga leve a moderada (52,9%). Emergiram quatro categorias analíticas sobre elementos desencadeadores da sobrecarga materna. Conclusões: Urge identificação da sobrecarga materna relacionada aos cuidados de crianças com transtorno do espectro autista, durante a assistência na Atenção Primária à Saúde.
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Liu R, Dong H, Wang Y, Lu X, Li Y, Xun G, Ou J, Shen Y, Xia K, Zhao J. Sleep Problems of Children with Autism May Independently Affect Parental Quality of Life. Child Psychiatry Hum Dev 2021; 52:488-499. [PMID: 32725386 DOI: 10.1007/s10578-020-01035-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
The current study explored how and to what extent sleep problems in children with autism spectrum disorder (ASD) impacted their parents' quality of life (QOL). A total of 440 ASD children and 344 age-matched typically developing (TD) children were included in the case-control designed study. In the TD group, a linear regression model showed that the Children's Sleep Habits Questionnaire (CSHQ) total scores were negatively associated with maternal mental health summary (MCS) scores in the SF-36v2 (β = - 2.831), while in the ASD group, the CSHQ total scores were negatively associated with the parental physical health summary (PCS) scores (β = - 3.030 for mothers, β = - 3.651 for fathers). Path analysis showed that sleep problems in ASD children had both direct and indirect effects on maternal PCS scores. The results indicated that sleep problems in children with ASD might affect parental QOL differently from TD children, and act as independent impact factors on parental physical health.
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Affiliation(s)
- Ruiting Liu
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Huixi Dong
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ying Wang
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xiaozi Lu
- Qingdao Mental Health Center, Qingdao, Shandong, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guanglei Xun
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Jianjun Ou
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Yidong Shen
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Kun Xia
- Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Jingping Zhao
- National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
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20
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The Effectiveness of Mirroring- and Rhythm-Based Interventions for Children with Autism Spectrum Disorder: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00236-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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21
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Autism spectrum disorder and severe social impairment associated with elevated plasma interleukin-8. Pediatr Res 2021; 89:591-597. [PMID: 32330928 DOI: 10.1038/s41390-020-0910-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/15/2019] [Accepted: 11/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disorder with an unclear etiology and pathophysiology. Previous studies have indicated that the dysregulation of cytokines may be involved in the pathogenesis of ASD and that the levels of cytokines may serve as potential biomarkers of this disorder. METHODS The current study employed a family triad-based case-control design to study the levels of plasma cytokines in families with ASD (n = 45 triads) and controls (n = 38 triads) with a Human Cytokine Twenty-Five-Plex Kit. The Social Responsiveness Scale (SRS) was used to measure social impairment of ASD children. RESULTS After controlling for the levels of parental cytokines, we identified that interferon-α (IFN-α), interleukin-7 (IL-7), IL-8, IFN-γ-inducible protein-10, and macrophage inflammatory protein-1β were associated with ASD, and IL-8 was the only cytokine also associated with the levels of both parental cytokines in the offspring-parents regression analysis and three subdomains of SRS (social awareness, cognition, and motivations) in the children with ASD. The receiver operating characteristic curve showed that the log-transformed IL-8 level discriminated children with autism from controls with an area under the curve of 0.858 (95% confidence interval: 0.777-0.939). CONCLUSIONS Our study suggests that IL-8 is a potential biomarker for ASD and may be involved in the pathogenesis of ASD. IMPACT The study suggests that IL-8 is a promising biomarker for ASD and may be involved in the pathogenesis of ASD. Only a very few studies have reported the parental cytokine levels. The significant strength of this article is that we applied the family triad-based approach to explore cytokine levels in families with autism and controls. There are no objective biomarkers, making the accurate diagnosis, prognostic prediction and effective treatment difficult, and our study provides promising results.
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Xia C, Sun M, Li X, Lu C, Gao X, Lu J, Chen G. Health-Related Quality of Life and Related Factors among Primary Caregivers of Children with Disabilities in Shanghai, China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9299. [PMID: 33322674 PMCID: PMC7764603 DOI: 10.3390/ijerph17249299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022]
Abstract
Health-related quality of life (HRQOL) of caregivers of children with disabilities (CWD) is important for both children's rehabilitation and caregivers' life, but the corresponding attention is far from enough in mainland China. Thus, we investigated the HRQOL of 170 caregivers and related factors in Shanghai. The 12-item Short Form Health Survey (SF-12) was used to measure HRQOL. The potential factors were collected, including child characteristics, caregiver characteristics, and environmental factors. Univariate analysis and multiple linear regression were performed to identify the key factors that could be intervened. Compared with the general population, caregivers of CWD had a slightly higher score on the physical component summary (PCS, 52.57 ± 8.41), but the score of mental component summary (MCS, 31.58 ± 7.72) was extremely low. Caregiver's illness condition, family size, and household income were significant factors of physical HRQOL. Caregivers with illness and caregivers living in an extended family were associated with higher mental HRQOL. Whereas these two factors had opposite effects on physical HRQOL. This finding indicated poor mental HRQOL among caregivers of CWD in Shanghai and thus requiring urgent attention and intervention. Improving physical fitness, maintaining family integration, and providing financial support should be considered when developing intervention for this population.
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Affiliation(s)
- Cong Xia
- School of Public Health, Fudan University, Shanghai 200032, China; (C.X.); (M.S.); (X.L.); (X.G.)
- China Research Center on Disability, Fudan University, Shanghai 200032, China
| | - Mei Sun
- School of Public Health, Fudan University, Shanghai 200032, China; (C.X.); (M.S.); (X.L.); (X.G.)
- China Research Center on Disability, Fudan University, Shanghai 200032, China
| | - Xinying Li
- School of Public Health, Fudan University, Shanghai 200032, China; (C.X.); (M.S.); (X.L.); (X.G.)
- China Research Center on Disability, Fudan University, Shanghai 200032, China
| | - Chenhao Lu
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Xiu Gao
- School of Public Health, Fudan University, Shanghai 200032, China; (C.X.); (M.S.); (X.L.); (X.G.)
- China Research Center on Disability, Fudan University, Shanghai 200032, China
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai 200032, China; (C.X.); (M.S.); (X.L.); (X.G.)
- China Research Center on Disability, Fudan University, Shanghai 200032, China
| | - Gang Chen
- School of Public Health, Fudan University, Shanghai 200032, China; (C.X.); (M.S.); (X.L.); (X.G.)
- China Research Center on Disability, Fudan University, Shanghai 200032, China
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Lei X, Kantor J. Social support and family quality of life in Chinese families of children with autism spectrum disorder: the mediating role of family cohesion and adaptability. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:454-461. [PMID: 35937173 PMCID: PMC9351563 DOI: 10.1080/20473869.2020.1803706] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/22/2020] [Accepted: 07/27/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND The current study examined the interrelations among social support, family quality of life (FQOL), and family cohesion and adaptability in Chinese families of children with autism spectrum disorder (ASD). METHODS A sample of 163 caregivers of children with ASD in China were surveyed with the Social Support Rating Scale, Beach Center Family Quality of Life Scale, and Chinese version of Family Adaptability and Cohesion Scale II, respectively. We used structural equation modeling to examine the mediating role of family cohesion and adaptability on the relationship between social support and FQOL. RESULTS The results indicated that social support had a positive impact on FQOL and that family cohesion and adaptability completely mediated the relationship between social support and caregivers' satisfaction on FQOL. CONCLUSIONS Facilitating family cohesion and adaptability by providing social support may be beneficial to help families of children with ASD improve their FQOL. The findings identified the need for developing targeted interventions for this population.
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Affiliation(s)
- Xianmei Lei
- College of Special Education, Leshan Normal University, Leshan City, Sichuan Province, China
| | - Jiří Kantor
- Institute of Special Educational Studies, Palacký University, Olomouc, Czech Republic
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Wang Y, Li N, Yang JJ, Zhao DM, Chen B, Zhang GQ, Chen S, Cao RF, Yu H, Zhao CY, Zhao L, Ge YS, Liu Y, Zhang LH, Hu W, Zhang L, Gai ZT. Probiotics and fructo-oligosaccharide intervention modulate the microbiota-gut brain axis to improve autism spectrum reducing also the hyper-serotonergic state and the dopamine metabolism disorder. Pharmacol Res 2020; 157:104784. [PMID: 32305492 DOI: 10.1016/j.phrs.2020.104784] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
Abstract
The prevalence of autism spectrum disorders (ASD) is increasing, but its etiology remains elusive and hence an effective treatment is not available. Previous research conducted on animal models suggests that microbiota-gut-brain axis may contribute to ASD pathology and more human research is needed. This study was divided into two stages,.At the discovery stage, we compared the differences in gut microbiota profiles (using 16S rRNA sequencing), fecal SCFAs (using GC-MS) and plasma neurotransmitters (using UHPLC-MS/MS) of 26 children with ASD and 24 normal children. All 26 children with ASD participated in the intervention stage, and we measured the gut microbiota profiles, SCFAs and neurotransmitters before and after probiotics + FOS (n = 16) or placebo supplementation (n = 10). We found that gut microbiota was in a state of dysbiosis and significantly lower levels of Bifidobacteriales and Bifidobacterium longum were observed at the discovery stage in children with ASD. An increase in beneficial bacteria (Bifidobacteriales and B. longum) and suppression of suspected pathogenic bacteria (Clostridium) emerged after probiotics + FOS intervention, with significant reduction in the severity of autism and gastrointestinal symptoms. Compared to children in the control group, significantly lower levels of acetic acid, propionic acid and butyric acid were found, and a hyperserotonergic state (increased serotonin) and dopamine metabolism disorder (decreased homovanillic acid) were observed in children with ASD. Interestingly, the above SCFAs in children with autism significantly elevated after probiotics + FOS intervention and approached those in the control group. In addition, our data demonstrated that decreased serotonin and increased homovanillic acid emerged after probiotics + FOS intervention. However, the above-mentioned changes did not appear in the placebo group for ASD children. Probiotics + FOS intervention can modulate gut microbiota, SCFAs and serotonin in association with improved ASD symptoms, including a hyper-serotonergic state and dopamine metabolism disorder.
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Affiliation(s)
- Ying Wang
- Shandong Children's Microbiome Center, Research Institute of Pediatrics, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China; State Key Laboratory of Microbial Technology, Shandong University, Qingdao, Shandong, China.
| | - Ning Li
- Institute of Child Health Care, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China.
| | - Jun-Jie Yang
- College of Life Science, Qilu Normal University, Jinan, Shandong, China.
| | - Dong-Mei Zhao
- Institute of Child Health Care, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China.
| | - Bin Chen
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Key Laboratory of Big Data-Based Precision Medicine (Beihang University), the Ministry of Industry and Information Technology of the People's Republic of China, Beijing, China.
| | - Guo-Qing Zhang
- Bio-Med Big Data Center, CAS Key Laboratory of Computational Biology, CAS-MPG Partner Institute for Computational Biology, Shanghai Institute of Nutrition and Health, Shanghai, China.
| | - Shuo Chen
- Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China; CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China.
| | - Rui-Fang Cao
- Bio-Med Big Data Center, CAS Key Laboratory of Computational Biology, CAS-MPG Partner Institute for Computational Biology, Shanghai Institute of Nutrition and Health, Shanghai, China.
| | - Han Yu
- Shandong Children's Microbiome Center, Research Institute of Pediatrics, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China.
| | - Chang-Ying Zhao
- Shandong Children's Microbiome Center, Research Institute of Pediatrics, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China.
| | - Lu Zhao
- Shandong Children's Microbiome Center, Research Institute of Pediatrics, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China.
| | - Yong-Sheng Ge
- Shandong Children's Microbiome Center, Research Institute of Pediatrics, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China.
| | - Yi Liu
- Shandong Children's Microbiome Center, Research Institute of Pediatrics, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China.
| | - Le-Hai Zhang
- Shandong Children's Microbiome Center, Research Institute of Pediatrics, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China.
| | - Wei Hu
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, Shandong, China.
| | - Lei Zhang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Key Laboratory of Big Data-Based Precision Medicine (Beihang University), the Ministry of Industry and Information Technology of the People's Republic of China, Beijing, China; Microbiome Research Center, Shandong Institutes for Food and Drug Control, Shandong Institute of Industrial Technology for Health Sciences and Precision Medicine, Jinan, Shandong, China.
| | - Zhong-Tao Gai
- Shandong Children's Microbiome Center, Research Institute of Pediatrics, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China.
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Alenazi DS, Hammad SM, Mohamed AE. Effect of autism on parental quality of life in Arar city, Saudi Arabia. J Family Community Med 2020; 27:15-22. [PMID: 32030074 PMCID: PMC6984034 DOI: 10.4103/jfcm.jfcm_157_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/20/2019] [Accepted: 11/07/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The quality of life (QOL) of the families of children with autism is lower than that of families of normal children or children with other disabilities. The study's aim was to describe the severity of effect on the domains of the QOL of caregivers of autistic children and to identify the characteristics of caregivers and children associated with impaired QOL. MATERIALS AND METHODS This cross-sectional study included 84 parents of autistic children attending developmental abnormalities clinic in Arar city during January 1 to March 31, 2019. Parents of autistic children were interviewed using an Arabic version of the short-form 36 to assess their QOL. A mean score of <50 was considered to indicate poor QOL. Collected data were analyzed using the Statistical Package for the Social Sciences (SPSS, version 20.0). A Chi-square test was used for comparison between categorical variables. RESULTS Of 84 caregivers, 63.1% had impaired QOL. The main domains affected were energy/fatigue and role limitations resulting from emotional problems. Female gender, unemployment, and low income of caregivers were significant factors associated with poor QOL. Autistic children of the first birth order and with long duration of the disease were more likely to be associated with poor parental QOL. Gender, income, occupation, and duration of illness were associated with poor quality of life, but this was not statstically significant. CONCLUSION Slightly less than two-thirds of the caregivers had impaired QOL. Caregivers of autistic children need social and emotional support to help them to cope with this disability.
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Affiliation(s)
- Dalal S. Alenazi
- Department of Community Medicine, Saudi Board of Family Medicine Joint Program, Arar, Saudi Arabia
| | - Sabry M. Hammad
- Department of Community Medicine, Saudi Board of Family Medicine Joint Program, Arar, Saudi Arabia
- Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amal E. Mohamed
- Department of Community Medicine, Saudi Board of Family Medicine Joint Program, Arar, Saudi Arabia
- Department of Public Health, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Wang Y, Lin J, Zeng Y, Liu Y, Li Y, Xia K, Zhao J, Shen Y, Ou J. Effects of Sleep Disturbances on Behavioral Problems in Preschool Children With Autism Spectrum Disorder. Front Psychiatry 2020; 11:559694. [PMID: 33633594 PMCID: PMC7900493 DOI: 10.3389/fpsyt.2020.559694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/22/2020] [Indexed: 01/30/2023] Open
Abstract
Study Objectives: This study aims to identify the characteristic sleep disturbances that affect behavioral problems in children with autism spectrum disorder (ASD), providing a potential direction for sleep and behavioral intervention in ASD. Methods: The data of 513 children with ASD and 246 typically developing (TD) children aged between 2 and 5 years old were collected. The behavior performance of preschool children was assessed using the Child Behavior Checklist for 1.5-5.0 years old. The Children's Sleep Habits Questionnaire (CSHQ) was used to measure the sleep status of the children, and the Social Responsiveness Scale was used to measure the severity of disorder. Linear regression analysis was performed to examine the effects of sleep disturbances on behavioral problems, and independent-sample t-test was performed to compare the mean of the samples. Results: Compared to TD children, children with ASD had longer sleep onset delay and more night awakenings. The parasomnias score (a subscale of the CSHQ) was significantly associated with the internalizing (β = 0.113, P = 0.010), externalizing (β = 0.128, P = 0.006), and total problems (β = 0.143, P = 0.001) of children with ASD, while this association was not significant in TD children. "Bed wetting" and "restless and moves a lot" (two items in the CSHQ under parasomnia) significantly only affected the overall behavioral score in children with ASD (P < 0.05). Conclusion: Parasomnias, especially bed wetting and restlessness, are specifically associated with the behavioral problems of children with ASD rather than TD children.
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Affiliation(s)
- Ying Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jingjing Lin
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Zeng
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanan Liu
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Yamin Li
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Kun Xia
- State Key Laboratory of Medical Genetics, Central South University, Changsha, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yidong Shen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jianjun Ou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
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